Developing and applying a training needs analysis tool for healthcare workers managing snakebite envenoming: A cross-sectional study in Eswatini

Abstract

A considerable number of patients present to hospitals in Eswatini each year following bites by venomous snakes. Effectively diagnosing and treating patients with snakebite envenoming requires healthcare workers to have a variety of generic and snakebite-specific medical skills. In several countries, however, healthcare workers have been found to have limited skills in managing snakebite patients. We used the Delphi method to adapt the Hennessy-Hicks training needs analysis questionnaire to the context of snakebite envenoming and subsequently used the adapted questionnaire to assess the self-perceived training needs of 90 healthcare workers from ten hospitals in Eswatini. Two-thirds (63%) of participants were nursing staff and one third (34%) medical doctors. Overall, 74% of healthcare workers had previously received training on snakebite. Although a training need was reported for all skills included in the survey, the extent of the training need varied between different skills and groups of healthcare workers. The highest average training need was registered in the domains 'research and audit' and 'clinical tasks' with the latter accounting for nine of the ten skills with the highest training need. Nurses reported a higher training need than doctors, especially for clinical tasks. Receiving snakebite training before as well as after obtaining the primary qualification was associated with the lowest average training need, particularly in clinical skills. Ninety-three percent of interviewed healthcare workers would welcome more frequent training opportunities on the clinical management of snakebite patients. This newly developed snakebite training needs analysis tool can aid in adapting training initiatives to a dynamic and evolving healthcare workforce and it is designed to be transferrable to snakebite endemic settings worldwide.

Fig 1. Map of Eswatini showing the location of the ten health facilities included in the healthcare worker survey.

Based on geoBoundaries country dataset (CC BY 4.0 License) by Runfola et al. [31] and created using ArcGIS software version 10.8.1, ESRI Inc., Redlands, CA, U.S.A (modified to include names of regions and hospital locations). ‘RES’ denotes clinics operated by the Royal Eswatini Sugar Corporation.

Fig 2. Graph showing the mean importance and performance rating of all HCWs (n = 90) for skills ranked 1–20 according to mean training need.

Skills are ranked according to the difference between importance and performance ratings, which is depicted as the horizontal distance between the dashed and solid lines. Skills were abbreviated; the exact phrasing of skills can be found in the SB-TNA tool provided in the S2 Appendix. An overview of skills grouped according to domain is provided in the S3 Appendix.

Fig 3. Graph showing the mean importance and performance rating of all HCWs (n = 90) for skills ranked 21–40 according to mean training need.

Skills are ranked according to the difference between importance and performance ratings, which is depicted as the horizontal distance between the dashed and solid lines. Skills were abbreviated; the exact phrasing of skills can be found in the SB-TNA tool provided in the S2 Appendix. An overview of skills grouped according to domain is provided in the S3 Appendix.

Fig 4. Mean training need for medical doctors (n = 31) and nurses (n = 57) shown per competency domain.

The number of skills per domain are 24 (Clinical tasks), 3 (Research and audit), 2 (Administration), 6 (Management and supervisory tasks) and 5 (Communication and teamwork). Error bars represent standard errors.

Fig 5. Training need of 90 HCWs who either did or did not receive different forms of training on snakebite management during different stages of their education/ careers.

Group sizes are as follows: Training during primary qualification (n = 8), No training (n = 23), Training after primary qualification only (n = 38), and Training during and after primary qualification (n = 21). Error bars represent standard errors.

Fig 6. Mean training need for HCWs who received training on snakebite management after completing their primary qualification (n = 59) versus HCWs who had not (n = 31).

The number of skills per domain are 24 (Clinical tasks), 3 (Research and audit), 2 (Administration), 6 (Management and supervisory tasks) and 5 (Communication and teamwork). Error bars represent standard errors.